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Comparative Billing Reports

CBR201801 Statistical Debriefing

CBR201801

Introduction

The following is a description of the tables used in CBR201801 Opioid Prescribers. There are links that will open the excel files that contain specialty and national statistics used in the analysis of prescribing providers for CBR201801. This report is an analysis of providers submitted as the “Prescribing NPI” on Medicare Part D claims extracted from the Integrated Data Repository based on the latest version of claims as of October 26, 2017. The analysis includes claims with dates of service from July 1, 2016 to June 30, 2017. National drug codes for opioids were drawn from a listing by the Center for Disease Control and Prevention, where there was a known morphine milligram equivalent conversion factor for the drug. Beneficiaries with cancer (ICD-10 diagnosis C00-D49) and/or in hospice for any time from July 1, 2016 - June 30, 2017 were excluded from the analysis. Examples of each table can be found in the CBR201801 sample.

The Morphine Equivalent Dose (MED) was first calculated for each prescription. The prescription data was then expanded to include daily records for each provider/beneficiary by adding together all drugs prescribed for each day, combining MEDs if the beneficiary had any overlapping prescriptions. Ninety-day rolling averages were calculated on the daily MEDs for each prescribing provider and beneficiary combination. All beneficiaries with a rolling 90-day average MED of 90 or above were identified. The percentage was calculated as the number of beneficiaries identified for receiving at least 90 MED for at least 3 months, divided by the total number of beneficiaries prescribed opioids by this provider, multiplied by 100. Table 2 provides an analysis of this data.

Using the expanded daily MED calculation described above, the total number of days that each beneficiary was prescribed opioids was calculated for each provider. This calculation does not account for days when a beneficiary was under multiple prescriptions. The average for each provider is calculated by taking the sum of all days prescribed, divided by the total number of beneficiaries. Each provider’s percentage is compared to his/her specialty and the nation using the t-test at the alpha value of 0.05. Table 3 provides an analysis of this data.

The total cost of each drug was calculated from the claims information and summed for each beneficiary. The average charges per beneficiary was calculated for each provider as the total costs for all drugs prescribed divided by the total number of beneficiaries. Each provider’s average is compared to his/her specialty and the nation using the t-test at the alpha value of 0.05. Table 4 provides an analysis of this data.

Table 5 - Percentage of Beneficiaries Prescribed Opioids by Four or More Providers

All beneficiaries prescribed opioids by four or more different prescribing providers were identified. The percentage was calculated for each individual provider as the number of beneficiaries identified as prescribed opioids by four or more prescribers divided by the total number of beneficiaries prescribed opioids by this provider, multiplied by 100. For more information on other prescriptions that your beneficiaries are receiving, please consult the information on PDMPs and OMS on our CBR201801-recommended-links page. Each provider’s percentage was compared to the percentages of his/her specialty and the nation using the chi-square test at alpha=0.05. Table 5 provides an analysis of this data.